Gross C M, Krämer J, Waigand J, Uhlich F, Dietz R
Franz-Volhard-Klinik am Max-Delbrück-Centrum Abteilung für molekulare und klinische Kardiologie Charité Universitätsklinikum, Medizinischen Fakultät, Humboldt-Universität zu Berlin.
Z Kardiol. 2000 Sep;89(9):747-53. doi: 10.1007/s003920070177.
To explore the relationship between coronary artery disease and renal vascular disease, we performed renal arterial angiography in 609 patients undergoing coronary angiography for suspected coronary artery disease. We defined renal artery stenosis as nonsignificant (< 40%), borderline (40-60%) and significant (> 60%). One-hundred fifty-two patients had renal artery stenosis, while 457 did not. Two-hundred and ten patients had no coronary disease; of these, only 9 had renal artery stenosis. On the other hand, the 143 patients with renal artery stenosis, when subdivided, had similar degrees of coronary disease; three vessel disease was significantly more common than one or two vessel disease in all groups. Renal artery stenosis of all severity degrees was associated with common atherosclerotic risk factors. However, hypertension was not a clue to the presence of renal artery stenosis. To evaluate the effect of percutaneous revascularization on hypertension and renal function all 51 patients with significant renal artery stenosis were treated by primary stent implantation and were followed up for 6 months. Stent implantation showed a marked decrease in systolic and diastolic blood pressure (163 +/- 30 to 145 +/- 17 and 93 +/- 18 to 83 +/- 10 mmHg; p = 0.008) with a decrease in the amount of antihypertensive medication but without beneficial effect on serum creatinine during follow-up (1.46 +/- 0.70 mg/dl to 1.39 +/- 0.58 mg/dl, p = ns). We conclude that renal artery stenosis of any severity is strongly suggestive of three vessel coronary artery disease. The fact that renal stenting lowers blood pressure decreases antihypertensive drugs and increases medication flexibility in patients with coronary artery disease would support the notion of revascularization in patients with significant stenoses.
为了探究冠状动脉疾病与肾血管疾病之间的关系，我们对609例因疑似冠状动脉疾病而接受冠状动脉造影的患者进行了肾动脉造影。我们将肾动脉狭窄定义为轻度（<40%）、临界（40 - 60%）和重度（>60%）。152例患者存在肾动脉狭窄，而457例患者没有。210例患者没有冠心病；其中只有9例存在肾动脉狭窄。另一方面，143例肾动脉狭窄患者，细分后，其冠心病程度相似；在所有组中，三支血管病变比单支或双支血管病变明显更常见。所有严重程度的肾动脉狭窄都与常见的动脉粥样硬化危险因素相关。然而，高血压并非肾动脉狭窄存在的线索。为了评估经皮血管重建术对高血压和肾功能的影响，对所有51例重度肾动脉狭窄患者进行了初次支架植入治疗，并随访6个月。支架植入术后收缩压和舒张压显著降低（分别从163±30降至145±17 mmHg以及从93±18降至83±10 mmHg；p = 0.008），同时降压药物用量减少，但随访期间血清肌酐无改善（从1.46±0.70 mg/dl降至1.39±0.58 mg/dl，p =无统计学意义）。我们得出结论，任何严重程度的肾动脉狭窄都强烈提示三支血管冠状动脉疾病。肾动脉支架置入术可降低血压、减少降压药物用量并增加冠心病患者用药灵活性，这一事实支持了对重度狭窄患者进行血管重建术的观点。
